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A Telehealth Primer: Start Small, Make Adjustments, Scale Up

Brookwood Baptist Health launched its first virtual care platform for its employees. The Alabama health system is now preparing to open the service to its patients.

By Eric Wicklund

- Some of the best telehealth projects start small, prove their value, then scale up to make an even bigger impact on the community.

Such is the case with Brookwood Baptist Health, a five-hospital system in central Alabama that launched a virtual care platform less than two years ago for its 5,000 employees.

“We literally had a desk with a desktop computer, a camera and an Internet connection” and a few peripheral diagnostic devices, says Anne-Laura Cook, MD, FACP, MHCM, the health system’s medical director of population health management and primary care innovation. The kiosks were set up in two hospitals, with a nurse stationed to help with registration, and were available five days a week from 7:30 a.m. to 4:30 p.m. for a $40 visit.

Hospital officials were curious to see how the virtual care platform impacted the system’s health plan, and whether it appealed to a population that might still prefer to see a doctor in person. When more than 100 people showed up for session over the first month, they knew they had something valuable on their hands.

“Telemedicine is still obviously very new here; we’re still getting our feet wet,” says Cook, who used Google to research telehealth providers. “A lot of people really don’t understand what we can comfortable take care of” in a virtual visit.

Cook says the health system is now looking at rolling out virtual care to its existing patients within the primary care provider network, which comprises more than 100 physicians. The focus here will be on offering service after-hours and on weekends, and filling in gaps in the PCP network.

She is expecting a little bit of pushback.

“We’re still in that environment of moving from volume to value-based care,” she points out. “So this does represent a loss of revenue for some of our clinics. With our doctors we … have to walk a fine line” to prove that the service isn’t causing more headaches than it’s worth.”

Dave Skibinski, CEO of SnapMD, the Los Angeles-based telehealth provider that is powering Brookwood Baptists Health’s platform, says the health system is following a path taken by many small hospitals and health systems venturing for the first time into telehealth.

They start with a known, controlled population – their own employees - and chart everything from time and resources used to patient satisfaction to health plan impact to clinical outcomes. Based on those findings, the health system tinkers with the platform to iron out any glitches, then turns it around and rolls it out to its patient population. Eventually, a health system might open that platform up to the general population, offering on-demand care to whoever needs it.

“You learn something new every time one of these (providers) starts a new program,” says Skibinski, whose company is partnering with dozens of healthcare providers across the country. “A lot of them start from the same place” and branch out as they become comfortable with the platform.

Cook says the health system’s patients haven’t lobbied too hard for telehealth because many of them place a lot of value in in-person visits. The challenge lies in educating them on what they can do online, using a smartphone or a personal computer at home.

“I think there will be interest once they get used to it and see what it can do,” she says.

Her dream is to see the platform extended to “anything where telemedicine in the long run can save us money.” That includes helping patients with chronic conditions manage their care at home, remote patient monitoring, and enabling primary care doctors to conduct virtual visits.

“We’re still kind of feeling it out,” she says. “We want to be cautious, but at the same time we want to be innovative.”

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